Diagrammatic recording of head and neck tumours1

The increasing demands of clinical audit have resulted in the need for accurate data collection. The use of tumour maps allows standardization of the records of patients with head and neck cancer, which facilitates collation of data in multicentre studies and makes interdepartmental comparisons more meaningful. The aim of this study was to develop an improved standard set of tumour maps for recording the stage of head and neck tumours. A review of the existing tumour diagrams was performed to identify those anatomical areas that are not adequately represented or where ambiguity exists. The areas where improvements could be made were identified as: (1) the anterior commissure of the larynx; (2) axial and sagittal views of the larynx; (3) the pyriform fossa and cervical oesophagus; (4) the oropharynx and vallecula; (5) the nasal cavity and paranasal sinuses; and (6) cervical nodal involvement. A new set of tumour maps is presented in an attempt to correct some of the limitations of the existing diagrams.     

食管腺癌淋巴结转移与肿瘤侵及食管壁深度的关系

目的 对腺癌侵及食管壁深度与淋巴结转移的关系以及淋巴结转移对预后的影响进行分析研究.方法 澳大利亚弗林德斯大学医学中心自1985年～2003年,手术治疗食管腺癌121例.其中男101例,女20例.年龄36～80岁,平均62岁.本组手术切除率为96.7%（117/121例）.手术清扫淋巴结的数目每例为2～30个,平均8个.无淋巴结转移59例（48.8%）、有淋巴结转移62例（51.2%）.本组病例全部得到随访.结果 当肿瘤位于黏膜层或黏膜下层（T1）时,淋巴结转移的发生率为22.2%（10/45例）、平均淋巴结转移的个数为0.3个、＞4个淋巴结转移的比例为0（0/45例）;当肿瘤侵及食管周围组织（T4）时,淋巴结转移的发生率为85.7%（6/7例）、平均淋巴结转移的个数为5.1个、＞4个淋巴结转移的比例为71.4%（5/7例）,P＜0.05.无淋巴结转移组的5年生存率为52.9%、1～4个淋巴结转移组的5年生存率为11.5%、＞4个淋巴结转移组的5年生存率为0,P＜0.01.结论 肿瘤对食管壁侵及深度和淋巴结转移的发生率及淋巴结转移的数量之间存在正相关性.随着肿瘤对食管壁侵及深度的增加,淋巴结转移的发生率、平均淋巴结转移的数量和＞4个淋巴结转移的比例均增加.有无淋巴结转移和淋巴结转移的数量是影响远期生存率的一个重要因素.     

Association between age and clinical characteristics of renal cell carcinoma in adult patients

AIM: To study the association between age and clinical characteristics of renal cell carcinoma in adult patients. METHODS: Three hundred and ten patients with renal cell carcinoma were classified into three groups: or=60 years group. The clinical characteristics of the three groups were compared to define the association. RESULTS: The male/female ratio was 1.3/1, 2.0/1, 3.3/1 in the three groups, respectively, and a significant difference appeared when comparing the or=60 years group (P=0.010). The respective percentage of incidental renal cell carcinoma was 27.9%, 43.2%, 31.2%, and it was significantly higher in the 41-59 years group than the >or=60 years group (P=0.047). The incidence of poorly differentiated renal cell carcinoma decreased with age increasing (11.6% vs 5.2% vs 2.7%), and there was significant difference between the or=60 years group (P=0.038). In the 相似文献   

Staging-laparoscopy

Summary. The so-called extended diagnostic laparoscopy (EDL) facilitates the comprehensive exploration of the abdominal cavity, thus improving the precision of the pretherapeutic tumor staging in gastrointestinal malignancies. EDL comprises visual inspection with a specific preparation of all relevant sites, laparoscopic sonography and retrieval of samples for biopsy and cytology. Additional relevant therapeutic information was obtained through EDL in 40.5 % of gastric cancer patients. EDL could be of similar importance for diagnosing esophageal, hepatobiliary and pancreatic malignancies.      

原发性肝癌的分期、根治切除标准及预后指标

论述了原发性肝癌的分期方案，根治切除标准及预后指标。三者的研究进展及相互间的关系。肝癌临床分期尚没有统一的实用方案，TNM分期随着不断修订，得到了一定的认可和推广。我国1999年修订的方案大致与TNM分期相对应，目前也没有通用的肝癌切除根治标准，临床上通常分为根治性切除与姑息性切除两类，比较笼统，在细胞病理学的基础上可分为病理根治性，临床根治性和姑息性切除三类，多因素分析表明，影响肝癌总体预后的因素主要是肿瘤分期，病理类型，治疗措施。肿瘤生物学特性以及并发症，而影响手术后复发和转移的因素主要是手术切除程度和病理特征，临床分期是选择治疗方案的基础。预后分析则是验证肝癌的分期和根治切除标准是否合理的手段；肝癌的准确分期，根治切除的判断及预后水平的提高均有赖于分子生物学技术的进步。     

The relationship of proliferating cell density at the invasive tumour front with prognostic and risk factors in human oral squamous cell carcinoma

BACKGROUND: We hypothesise that the density of proliferating cells at the invasive tumour front (ITF) has a positive relationship with prognostic and risk factors in human oral squamous cell carcinoma (SCC). METHODS: Tissues from 47 human oral SCC specimens were collected and stained with a monoclonal antibody directed against the Ki-67 antigen using a horseradish peroxidase based two-step immunostaining method. Counting was performed on two parallel sections at the ITF using an image analyser. The Ki-67 labelling index (LI) was determined by measuring the number of nuclei/mm(2) of epithelium. RESULTS: Our results show that the density of proliferating cells is related to clinical staging, with advanced stage of disease having a significantly higher Ki-67 LI compared with early stage of disease (2111 +/- 905 vs. 1908 +/- 913; P = 0.03). Importantly, this study shows that tumours that have metastasised have a significantly higher Ki-67 LI than tumours where distant metastasis was not detected (3257 +/- 650 vs. 1966 +/- 881; P < 0.0001). CONCLUSIONS: Cell proliferation, as measured by the Ki-67 LI at the ITF, has a positive relationship with clinical staging, tumour thickness, smoking status of the patient and alcohol consumption. Further, we suggest that a multicenter study with a large cohort of patients is indicated to fully elucidate whether cell proliferation at the ITF is directly related to patient survival.     

Developments in treatment of primary irresectable rectal cancer

Abstract The treatment options for primary irresectable rectal cancers are discussed. Assessment of tumour stage is the first step for an appropriate choice of treatment. Following a diagnosis of rectal cancer, a vast array of diagnostic procedures is available to determine its stage, and thereby its best treatment options. From the many (new) diagnostic options the merits and drawbacks are discussed. If a diagnosis of irresectability is made, further treatment options should include radiotherapy in most cases, some aspects of timing and application, i.e. intra-operative treatment are discussed. Chemotherapy options are manifold, the results are discussed and some new options are explored.     

醒脑静注射液治疗缺血性中风急性期随机对照试验的系统评价

目的 系统评价醒脑静注射液治疗缺血性中风急性期的疗效及安全性。方法 集醒脑静注射液治疗缺血性中风急性期随机对照试验文献，筛选合格研究，应用Jadad评分法进行质量评价，运用异质性检验、Meta-分析、漏斗图分析、敏感性分析等方法统计相关数据。结果 项研究符合纳入标准，Jadad评分所有研究得分均低于3分，属低质量文献。Meta-分析结果显示，总有效率比较的相对危险度（RR值）=1．04，99％的可信区间（CI值）为（0．88，1．23）。结论 前尚无充分证据证实醒脑静注射液治疗缺血性中风急性期的疗效及安全性。要进一步验证醒脑静注射液治疗缺血性中风急性期的疗效及安全性，尚需进行设计合理、执行严格、多中心大样本且随访时间足够的随机对照试验。     

对医院药事管理委员会系统工程管理的初探

本文通过对医院药事管理委员会的组织形式以及在医院药学事业中的特殊地位、工作任务、工作职责及职能效应的初步探讨,指出医院药事管理委员会在发展和建设医院药学事业中具有十三种职能、七大效应。认为加强医院药事管理委员会建设,是发展医院药学事业和保证医院药品质量的一种好方式。     

加强保健措施 降低孕产妇死亡率的试点研究

经调查河南省七县1988～04～1989～03孕产妇死亡率为136.1/10万,高于全国平均水平(94.7/10万)。从七县中选择了死亡率偏高的三个县(147.9/10万)为样本.进行厂降低农村孕产妇死亡率保健措施的研究。自1990年4月1日～1992年3月31日。在三县采取了以下保健措施:①加强基层妇幼卫生建设,特别是中心乡卫生院的建设,②整顿和完善三级保健网;③建全孕产妇系统管理制度,高危妊娠筛查,转化和转诊制度,④配备必要设备,建立联合小产院,实行定点接生。两年内孕产妇死亡率,由1989年的147.9/10万下降到67.7/10万,下降幅度为54.44%,最高达72.1%。此工作为实现2000年孕产妇死亡率下降一半的规划目标提供了依据。